Field Troubled By States’ Challenge To ACA Medicaid Provision
Mental Health Weekly January 17, 2012
Twenty-six states last week have added more fuel to the fire brewing regarding challenges to the health reform law when they filed a brief with the Supreme Court outlining their argument that the law’s Medicaid expansion is “unconstitutional coercion” and an “infringement” on state power.
Medicaid plays an essential role in expanding insurance coverage under the Patient Protection and Affordable Care Act (ACA). The reform law makes significant improvements to Medicaid including expanding the number of people who can qualify for extensive mental health services.
The newly eligible Medicaid population includes many people with mental health needs. Approximately one in six currently uninsured low-income adults (those with incomes below 133 percent of the federal poverty level) has a severe mental health disorder and many others have mental health service needs for less severe mental health disorders, according to a report by the Kaiser Commission on Medicaid and the Uninsured, in April 2011.
State attorney generals and governors filed the 123-page brief with the Supreme Court on Jan. 10. The 26 states are Alabama, Alaska, Arizona, Colorado, Georgia, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin, and Wyoming.
The Supreme Court will hear the legal challenges to the ACA in March.
At that time, according to Re becca Farley, policy association for the National Council for Community Behavioral Health Care (National Council), the Medicaid expansion and three other issues will be considered:
1) Is the individual mandate constitutional?;
2) If the mandate is struck down, can the rest of the law stand?; and
3) Do plaintiffs have legal standing to bring a lawsuit before the law goes into effect?
Although the issue regarding the constitutionality of the Medicaid expansion – which provides states with new money for Medicaid under the conditions they cover certain new populations – was broached by states in November, state officials had until last week to file a brief,
Farley told MHW.
Florida was the first state to initiate the lawsuit challenging the health reform law’s mandatory Medicaid-expansion requirements before being joined by 25 other states, she said. “State officials noted in the brief that the Medicaid expansion is unconstitutional because it commandeers powers that have traditionally been left to the state,” Farley said. “They feel coerced into providing coverage for these new populations.
They’re saying that because Medicaid is the single, largest source of federal funding for states, they can’t opt out of Medicaid because states rely on it so much.”
According to the Petitioners v.the U.S. Department of Health and Human Services, et al., the ACA purports to leave states’ participation in Medicaid nominally voluntary [when] in fact, no state will be able to reject its new terms and withdraw from the program.
The brief also noted that throughout Medicaid’s history, since its establishment in 1965, Congress has consistently “given the states substantial discretion to choose the proper mix of amount, scope and duration limitations on coverage, as long as care and services are provided in ‘the best interest of the recipients.’”
“The Medicaid expansion is very critical in order for individuals with mental health and addiction needs to gain access to health care,” said Farley.
Populations that the behavioral health safety net services also experience co-occurring disorders, chronic conditions and have a difficult time accessing services, she said.
Medical insurance is a crucial element of expanding coverage and improving health, Farley said. “Medicaid is a very crucial component of that,” she said.
Legal Arguments ‘Far-Reaching’
“The arguments that Florida and the other states involved in this lawsuit are making concerning Congress’s power to enact the Medicaid expansion are extremely troubling and far-reaching,” Jennifer Mathis, deputy legal director for the Bazelon Center for Mental Health Law, told MHW.
If the Court were to adopt these arguments, it would have dramatic implications for a host of laws enacted under Congress’s spending power, including child welfare, education, transportation safety, and other laws, said Mathis.
“The same arguments that Florida makes about the Medicaid expansion could potentially be used to invalidate laws such as No Child Left Behind and federal foster care laws,” she said. “The Supreme Court has never adopted such a restrictive notion of Congress’s spending power.” •